Claim Pitfalls, Complaints and Official Sources
How to verify a health insurance policy, insurer and agent in India: official sources
Check that an insurer, agent or web aggregator is IRDAI-registered, that your health policy is genuine, and which official portals to use for rules, tax, GST, PM-JAY and complaints.
Before paying for a health policy, check three things: that the insurer is registered with IRDAI to sell health insurance (general insurers and standalone health insurers both can), that the person or website selling it is a registered intermediary (agent, broker, corporate agent or web aggregator), and that the policy document comes from the insurer itself with a policy number you can confirm on the insurer's official website or helpline. Then use official sources, not social media posts, to check the rules: IRDAI for insurance rules, the Income Tax Department for tax, the GST Council and CBIC for GST, and the National Health Authority for Ayushman Bharat PM-JAY.
This guide is part of the overview of health insurance claim rejection reasons.
Who can sell you health insurance
| Seller | What to check |
|---|---|
| Insurer (general or standalone health insurer) | Appears in IRDAI's list of registered insurers |
| Individual agent | Has a licence from an insurer; ask for agent code and verify with the insurer |
| Corporate agent (often a bank) | Registered with IRDAI as a corporate agent |
| Insurance broker | Registered with IRDAI; brokers can offer products of several insurers |
| Web aggregator / insurance marketplace | Registered with IRDAI; check the registration number shown on the site against IRDAI's list |
| Point of Sales Person (POSP) | Allowed to sell certain simple products; linked to an insurer or intermediary |
Insurance can also be bought directly on the insurer's website. Whoever sells it, your contract is with the insurer.
Spotting fake policies and mis-selling
Warning signs:
- Premium payment to a personal bank account or UPI ID, not the insurer's
- "Policy" documents arriving as a PDF without the insurer confirming the number
- Offers of "lifetime cover for a one-time payment" or "no waiting periods" that the insurer's own documents do not show
- Pressure to sign blank proposal forms
- Calls claiming to be from IRDAI offering refunds or bonuses (IRDAI does not sell policies or pay bonuses)
Checks:
- Confirm the policy number with the insurer's official customer care, found on its own website.
- Make sure the premium receipt is in the insurer's name.
- Check that the proposal form you signed matches what you told the seller; ask for a copy.
- Read the policy during the 30-day free-look period and cancel if it is not what you were sold.
Official sources for each question
| Question | Official source |
|---|---|
| Rules on waiting periods, cashless timelines, portability, free look | IRDAI — master circulars on health insurance products and on policyholder protection |
| Is an insurer, broker or aggregator registered? | IRDAI — lists of insurers and intermediaries |
| Complaint against an insurer | Bima Bharosa |
| Insurance Ombudsman | Council for Insurance Ombudsmen |
| Health insurance tax deduction, regime choice | Income Tax Department, e-filing portal |
| GST on premiums | GST Council, CBIC |
| PM-JAY eligibility, Ayushman card, empanelled hospitals | PM-JAY, National Health Authority |
| Text of Acts | India Code |
| Consumer cases | e-Jagriti, National Consumer Helpline |
How to read an IRDAI circular
- Date and reference number at the top. Master circulars replace many older circulars; check that you are reading the latest.
- Applicability: which insurers and products, from which date.
- Definitions: terms like "pre-existing disease" and "moratorium" are defined; read them literally.
- Timelines: often expressed from a trigger (receipt of request, receipt of last document).
Insurers' own websites also publish public disclosures (financials and claims data) and policy wordings for each product. Download the wording and the Customer Information Sheet of the exact product and variant you are buying.
Worked example: checking a quote before paying
Illustrative. Sanjay receives a WhatsApp message offering a ₹10 lakh family health plan for ₹9,999 "with no waiting period, including pre-existing diseases".
- He searches IRDAI's list for the insurer named: it is registered.
- He asks for the product name and downloads its wording from the insurer's website. The wording shows a 36-month PED wait and a 1% room-rent cap.
- He asks the seller for the agent licence or intermediary registration; the seller stops replying.
- He buys a policy directly from an insurer's website after comparing two products with the quote comparison tool.
The claim "no waiting period" was not in the insurer's documents. Had he paid, he would have had either no policy or a policy different from what was promised.
Keep a policy file
- Policy schedule, wording, CIS and proposal form copy
- Premium receipts (for tax and continuity proof)
- Previous policies (for portability and the moratorium count)
- Claim records and correspondence
- Insurer and TPA helplines
Related: claim rejection reasons, complaints and the Ombudsman, cashless claims.
Frequently asked questions
Can I verify a health card's validity?
Yes: call the TPA or insurer helpline printed on the card and confirm the policy number, members and period. Do this before a planned admission.
Is a broker's policy as valid as one bought directly?
Yes. The policy is issued by the insurer. The broker's role is advice and service; check that it is IRDAI-registered.
Where do I find claims statistics?
IRDAI's annual report and insurers' public disclosures. Use them as background, alongside the wording.
Sources and where to check
- IRDAI — registered insurers and intermediaries, circulars
- Bima Bharosa — complaints
- National Health Authority — PM-JAY
- India Code — Insurance Act, Consumer Protection Act, Income-tax Act
